Provider Demographics
NPI:1568481653
Name:TWORKOWSKY, MELISSA (PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:TWORKOWSKY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33-39 COURT ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1325
Mailing Address - Country:US
Mailing Address - Phone:607-337-4700
Mailing Address - Fax:607-334-8306
Practice Address - Street 1:33-39 COURT ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1325
Practice Address - Country:US
Practice Address - Phone:607-337-4700
Practice Address - Fax:607-334-8306
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005458-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000082021OtherGHI-HMO
0598754OtherGHI-PPO
954161OtherMVP
1003208OtherCDPHP
EXCELLUS BC/BSOther201344838
P00216201OtherPALMETTO
1003208OtherCDPHP
000000082021OtherGHI-HMO
BA0265Medicare PIN
EXCELLUS BC/BSOther201344838
PA0422Medicare ID - Type Unspecified